78 Gastric Mucosa-associated Lymphoid Tissue Lymphoma

Clinical Presentation

A 63-year-old man complains of epigastric pain, chronic fatigue, and weight loss.

Fig. 78.1 (A,B) Contrast-enhanced CT images demonstrate circumferential thickening of the gastric antrum with associated gastric distention and lymphadenopathy.

Radiologic Findings

Contrast-enhanced computed tomography (CT) images (Fig. 78.1) demonstrate circumferential thickening of the gastric antrum with associated gastric distention and lymphadenopathy.

Diagnosis

Gastric mucosa-associated lymphoid tissue (MALT) lymphoma

Differential Diagnosis

Gastritis/gastric ulcer
Gastric metastases
Gastric carcinoma

Discussion

Background

The stomach represents the most common primary site of extranodal lymphomas in the gastrointestinal (GI) tract (65–75%), although these tumors account for only 2 to 5% of gastric primary malignancies. However, the relative frequency of gastric lymphoma, unlike that of carcinoma, has increased as a result of the acquired immunodeficiency syndrome (AIDS) epidemic. Lymphomas typically occur in patients ages 50 to 60 years and show no evidence of sex predilection. Chronic gastritis caused by Helicobacter pylori plays a major role in the development of lymphoid tissue (MALT), which is thought to be the precursor of gastric MALT lymphomas. At histology, MALT lymphomas can be classified into two types: low-grade (50–72% of cases) and high-grade, which probably results from the transformation of low-grade lymphomas.

Clinical presentation is usually nonspecific. Patients may experience symptoms mimicking gastritis or peptic ulcer disease, such as epigastric pain and dyspepsia. Other symptoms, such as low-grade fever, chronic fatigue, weight loss, and anemia, have been reported.